Skip to main content
SpringerLink
Log in

Acromegaly and end-stage renal disease: A diagnostic challenge

  • Case Report
  • Published:
Journal of Endocrinological Investigation Aims and scope Submit manuscript

Abstract

Chronic renal failure is associated with an impairment of the GH/IGF-I axis. We report the diagnostic challenges in a 72-yr-old female suffering from end-stage renal disease and presenting with clinical findings suggestive of acromegaly. GH was not suppressed during an oral glucose tolerance test, but rose paradoxically. However, serum IGF-I levels were within the normal range. IGF-binding proteins (IGFBP)-2 and -3 were markedly elevated and GH-binding protein (GHBP) was diminished. Clinical findings suspicious of acromegaly could be ascribed to pre-existing characteristics and consequences of end-stage renal disease. This suggested that the disturbances of the GH/IGF-I axis in our patient were due to chronic renal disease, rather than acromegaly. In the work-up for acromegaly, clinicians should be alerted to GH resistance in chronic renal failure.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Colao A, Ferone D, Marzullo P, Lombardi G. Systemic complications of acromegaly: epidemiology, pathogenesis, and management. Endocr Rev 2004, 25: 102–52.

    Article  CAS  PubMed  Google Scholar 

  2. Pokrajac-Simeunovic A, Trainer PJ. Pitfalls in the diagnosis of acromegaly. Horm Res 2004, 62 (Suppl 3): 74–8.

    Article  CAS  PubMed  Google Scholar 

  3. Rabkin R. Growth factor insensitivity in renal failure. Ren Fail 2001, 23: 291–300.

    Article  CAS  PubMed  Google Scholar 

  4. Roelfsema V, Clark RG. The growth hormone and insulin-like growth factor axis: its manipulation forthe benefit of growth disorders in renal failure. J Am Soc Nephrol 2001, 12: 1297–306.

    CAS  PubMed  Google Scholar 

  5. Samaan N, Cummings WS, Craig JW, Pearson OH. Serum growth hormone and insulin levels in severe renal disese. Diabetes 1966, 15: 546.

    Google Scholar 

  6. Wright AD, Lowy C, Fraser TR, Spitz IM, Rubenstein AH, Bersohn I. Serum-growth hormone and glucose intolerance in renal failure. Lancet 1968, 2: 798–801.

    Article  CAS  PubMed  Google Scholar 

  7. Wong NA, Ahlquist JA, Camacho-Hubner C, et al. Acromegaly or chronic renal failure: a diagnostic dilemma. Clin Endocrinol (Oxf) 1997, 46: 221–6.

    Article  CAS  Google Scholar 

  8. Schaefer F, Chen Y, Tsao T, Nouri P, Rabkin R. Impaired JAK-STAT signal transduction contributes to growth hormone resistance in chronic uremia. J Clin Invest 2001, 108: 467–75.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  9. Sun DF, Zheng Z, Tummala P, Oh J, Schaefer F, Rabkin R. Chronic uremia attenuates growth hormone-induced signal transduction in skeletal muscle. J Am Soc Nephrol 2004, 15: 2630–6.

    Article  CAS  PubMed  Google Scholar 

  10. Tönshoff B, Blum WF, Mehls O. Derangements of the somatotropic hormone axis in chronic renal failure. Kidney Int 1997, 58 (Suppl): S106–13.

    Google Scholar 

  11. Caufriez A, Abramowicz D, Vanherweghem JL, Copinschi G. Insulin-like growth factor I values in patients on maintenance hemodialysis: relationship to growth hormone and albumin levels. J Endocrinol Invest 1993, 16: 691–6.

    Article  CAS  PubMed  Google Scholar 

  12. Tönshoff B, Blum WF, Wingen AM, Mehls O. Serum insulin-like growth factors (IGFs) and IGF binding proteins 1, 2, and 3 in children with chronic renal failure: relationship to height and glomerular filtration rate. The European Study Group for Nutritional Treatment of Chronic Renal Failure in Childhood. J Clin Endocrinol Metab 1995, 80: 2684–91.

    Google Scholar 

  13. Zapf J, Walter H, Froesch ER. Radioimmunological determination of insulin like growth factors I and II in normal subjects and in patients with growth disorders and extrapancreatic tumor hypoglycemia. J Clin Invest 1981, 68: 1321–30.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  14. Juul A, Main K, Blum WF, Lindholm J, Ranke MB, Skakkebaek NE. The ratio between serum levels of insulin-like growth factor (IGF)-I and the IGF binding proteins (IGFBP-1, 2 and 3) decreases with age in healthy adults and is increased in acromegalic patients. Clin Endocrinol (Oxf) 1994, 41: 85–93.

    Article  CAS  Google Scholar 

  15. Renehan AG, Toogood AA, Ryder WD, et al. Paradoxical elevations in serum IGF-II and IGF binding protein-2 in acromegaly: insights into the regulation of these peptides. Clin Endocrinol (Oxf) 2001, 55: 469–75.

    Article  CAS  Google Scholar 

  16. Fukuda I, Hizuka N, Okubo Y, et al. Changes in serum insulin-like growth factor binding protein-2, -3, and -6 levels in patients with chronic renal failure following renal transplantation. Growth Horm IGF Res 1998, 8: 481–6.

    Article  CAS  PubMed  Google Scholar 

  17. Iglesias P, Diez JJ, Fernandez-Reyes MJ, et al. Growth hormone, IGF-I and its binding proteins (IGFBP-1 and -3) in adult uraemic patients undergoing peritoneal dialysis and haemodialysis. Clin Endocrinol (Oxf) 2004, 60: 741–9.

    Article  CAS  Google Scholar 

  18. Hasegawa Y, Cohen P, Yorgin P, Rosenfeld RG. Characterization of urinary insulin-like growth factor binding proteins. J Clin Endocrinol Metab 1992, 744: 830–5.

    Article  Google Scholar 

  19. Gargosky SE, Hasegawa T, Tapanainen P, MacGillivray M, Hasegawa Y, Rosenfeld RG. Urinary insulin-like growth factors (IGF) and IGF-binding proteins in normal subjects, growth hormone deficiency, and renal disease. J Clin Endocrinol Metab 1993, 76: 1631–7.

    CAS  PubMed  Google Scholar 

  20. Blum WF. Insulin-like growth factors (IGFs) and IGF binding proteins in chronic renal failure: evidence for reduced secretion of IGFs. Acta Paediatr Scand 1991, 379 (Suppl): 24–31.

    Article  CAS  Google Scholar 

  21. Tönshoff B, Powell DR, Zhao D, et al. Decreased hepatic insulin-like growth factor (IGF)-I and increased IGF binding protein-1 and -2 gene expression in experimental uremia. Endocrinology 1997, 138: 938–46.

    Article  PubMed  Google Scholar 

  22. Rabkin R, Schäfer F. New concepts: growth hormone, insulin-like growth factor-I and the kidney. Growth Horm IGF Res 2004, 14: 270–6.

    Article  CAS  PubMed  Google Scholar 

  23. Freda PU, Post KD, Powell JS, Wardlaw SL. Evaluation of disease status with sensitive measures of growth hormone secretion in 60 postoperative patients with acromegaly. J Clin Endocrinol Metab 1998, 83: 3808–16.

    CAS  PubMed  Google Scholar 

  24. Blum WF, Horn N, Kratzsch J, et al. Clinical studies of IGFBP-2 by radioimmunoassay. Growth Regul 1993, 3: 100–4.

    CAS  PubMed  Google Scholar 

  25. Tönshoff B, Cronin MJ, Reichert M, et al. Reduced concentration of serum growth hormone (GH)-binding protein in children with chronic renal failure: correlation with GH insensitivity. The European Study Group for Nutritional Treatment of Chronic Renal Failure in Childhood. The German Study Group for Growth Hormone Treatment in Chronic Renal Failure. J Clin Endocrinol Metab 1997, 82: 1007–13.

    Google Scholar 

  26. Villares SM, Goujon L, Maniar S, et al. Reduced food intake is the main cause of low growth hormone receptor expression in uremicrats. Mol Cell Endocrinol 1994, 106: 51–6.

    Article  CAS  PubMed  Google Scholar 

  27. Lim L, Spencer SA, McKay P, Waters MJ. Regulation of growth hormone (GH) bioactivity by a recombinant human GH-binding protein. Endocrinology 1990, 127: 1287–91.

    Article  CAS  PubMed  Google Scholar 

  28. Clark RG, Cunningham B, Moore JA, et al. Growth hormone binding protein enhances the growth promoting activity ofGH in the rat [Abstract]. Proceedings of the 73rd Annual Meet of The Endocrine Society 1991, 443.

  29. Roelen CA, Donker GH, Thijssen JH, Koppeschaar HP, Blankenstein MA. High affinity growth hormone binding protein in plasma of patients with acromegaly and the effect of octreotide treatment. Clin Endocrinol (Oxf) 1992, 37: 373–8.

    Article  CAS  Google Scholar 

  30. Kratzsch J, Blum WF, Ventz M, Selisko T, Birkenmeyer G, Keller E. Growth hormone-binding protein-related immunoreactivity in the serum of patients with acromegaly is regulated inversely by growth hormone concentration. Eur J Endocrinol 1995, 132: 306–1.

    Article  CAS  PubMed  Google Scholar 

  31. Saha MT, Saha HH, Niskanen LK, Salmela KT, Pasternack AI. Time course of serum prolactin and sex hormones following successful renal transplantation. Nephron 2002, 92: 735–7.

    Article  CAS  PubMed  Google Scholar 

  32. Takahashi T, Kato A, Ikegava N, et al. Ultrasound changes of the carpal tunnel in patients receiving long-term hemodialysis: a cross-sectional and longitudinal study. Clin Nephrol 2002, 57: 230–6.

    Article  CAS  PubMed  Google Scholar 

  33. Derwahl M, Studer H. Nodular goiter and goiter nodules: Where iodine deficiency falls short of explaining the facts. Exp Clin Endocrinol Diabetes 2001, 109: 250–60.

    Article  CAS  PubMed  Google Scholar 

  34. Payne RB, Carver ME, Morgan DB. Interpretation of serum total calcium: effects of adjustment for albumin concentration on frequency of abnormal values and on detection of change in the individual. J Clin Pathol 1979, 32: 56–60.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Endocrinology, Metabolism and Pathobiochemistry, Department of Internal Medicine, Germany

    K. Müssig MD, B. Gallwitz & H. U. Häring

  2. Pediatric Endocrinology Section, University Children’s Hospital Tübingen, Germany

    M. B. Ranke

  3. Department of Diagnostic Radiology, University Tübingen, Tübingen

    M. Horger

  4. Charité Campus Benjamin Franklin, Berlin, Germany

    H. J. Quabbe

Authors
  1. K. Müssig MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. B. Gallwitz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. B. Ranke
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M. Horger
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. H. U. Häring
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. H. J. Quabbe
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to K. Müssig MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Müssig, K., Gallwitz, B., Ranke, M.B. et al. Acromegaly and end-stage renal disease: A diagnostic challenge. J Endocrinol Invest 29, 745–749 (2006). https://doi.org/10.1007/BF03344187

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF03344187

En]Keywords

Search

Navigation